The American Thoracic Society (ATS) developed criteria for the diagnosis of refractory asthma. These can help identify a patient in a high risk category who requires more aggressive management.
(1) generally adherent to the treatment regimen
(2) other conditions excluded
(3) exacerbating factors have been identified and treated
(1) oral corticosteroids taken >= 50% of previous year (near continuous or continuous)
(2) requires high dose inhaled corticosteroid therapy (see previous section)
(1) requires daily controller medication in addition to inhaled corticosteroids
(2) requires short-acting beta-agonist on daily or near daily basis to control symptoms
(3) has persistent airway obstruction
(4) >= 1 urgent or emergency care visits for asthma in the past year
(5) >= 3 steroid "bursts" in the past year
(6) clinical deterioration shortly after any attempt to reduce oral or inhaled corticosteroid dose by <= 25% (steroid dependent)
(7) >= 1 near fatal asthma event in the past
• Persistent airway obstruction was defined as FEV1 less than 80% of predicted AND diurnal peak expiratory flow (PEF) variability > 20%.
• Daily controller medications include a long acting beta-agonist, theophylline, or a leukotriene antagonist.
Diagnosis of refractory anemia requires both of the following:
(1) at least 1 major criterion
(2) at least 2 minor criteria
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